Will Medicare pay for health care services in my home?
Typically, Medicare does not cover routine home care services such as daily assistance with medication, meal preparation and personal care like bathing and grooming.
Medicare won’t pay for home care services unless they are medically necessary and specifically ordered by your physician.
Home care services are covered by many private health insurance plans, and in some cases by veterans’ benefits. Some home care clients pay privately for services.
To receive Medicare coverage for healthcare services in your home, the following conditions must be met:
- You’re enrolled in Medicare
- You’re seeing a doctor for the condition that requires home care services
- Your doctor says you need skilled nursing care, physical therapy, speech therapy or occupational therapy because of an illness or injury
- You’ve seen a physician within the last 90 days or within 30 days of the start of home health care services, or you’ve been seen in an acute or post-acute setting by a physician who has admitting and treating privileges in that location
- Your physician certifies that you are homebound, meaning you cannot leave your home due to your injury or illness, or that leaving your home is a taxing effort that requires assistance
To be considered homebound, leaving your home must take a considerable effort and require assistance.
If you’re able to drive, you probably don’t meet the homebound requirement.
If you’ve been classified as homebound, it doesn’t mean you can never leave the house. You won’t lose your Medicare homebound classification if you only leave for short periods of time to:
- Attend religious services
- Go to a licensed, certified or accredited adult day services program
- Receive medical treatments
- Attend special events such as family reunions, funerals, graduations or weddings
If these criteria are met, Medicare may cover intermittent or part-time care. Generally, the care must be provided fewer than seven days a week, or fewer than eight hours a day. If requested by your doctor, Medicare may cover some exceptions for additional care.